Um, wow, the timing of your question is remarkable. Did you see Kurt Harris' recent blog post?

"5) When there is fructose in excess of glucose, or even when there is a large amount of fructose with glucose, there is often malabsorption in the small bowel – this can lead to rapid fermentation by bacteria in the colon, or abnormal overgrowth of bacteria in the distal small bowel. I speculate that fructose malabsorption is actually a defense mechanism to keep the liver from being overwhelmed by this metabolic poison, and the fact that we have not evolved a mechanism to handle big-gulp doses of fructose to the small bowel indicates modern quantities are likely outside of our evolutionary experience – the EM2."

...just don't send him an email asking medical advice. He hates that. :-)

Good luck. I can't imagine there's much in life more difficult than helping a child through a chronic medical condition.

Want him to gain? Grassfed Beef, lots of it. Whole Eggs are great growth food too.

Drop the Fruit, you're feeding bad bacteria in a gut that's clearly suffering from Bacteria issues. Once he's FULLY healed you Might consider adding it back in.

VLC is best for resetting gut bacteria. Tho if you can introduce naturally fermented foods, they do wonders.

Your kid is very lucky to have you.

I would suspect that fruit/fructose would be the problem. This would be present in the sweetener and in any fruit. Switch him to something like potato instead for a while and see how he does.

http://en.wikipedia.org/wiki/Fructose_malabsorption

Boy, I must give you kudos...sounds like you have done a ton of great testing and work. With a 4 yr old I can only imagine what it is like doing so many food changes.

My only thought, have you done any candida elimination diets?...essentially low sugar in all forms with natural antifungals (combined with everything else you are already doing...probiotics, eliminating known allergens).

Some items like coconut oil which are anti fungals can cause a large die off which can cause bloating and discomfort/fatigue....so those might need to be added slowly. After a period of very low sugar, slowly add back in some carbs (like potatoes rather then fructose) to aid in weight gain. Use ghee, avo, eggs, and fatty meats in the meantime to keep calories up.

Seriously, best of luck, hate seeing kids uncomfortable.

Poor thing! That's terrible. He must be really tough. I can only think you will need to try eliminating what you think is the most likely culprit and go one thing at a time and monitor very closely. However, it's only been 4 days on paleo so it's probably too early to really know for sure what direction it is going. Keep up with the food diary of course. You can probably let him have sweet potatoes as they are not nightshades and are not usually a prob. They should be no worse than fruit. What I might do if I were you is moderate fruit intake, allow some sweet potato, keep up with the rest of the paleo, and just wait a bit more and see how it goes. I know there is a strong instinct to fix it immediately, but sometimes/often rapid switching things around just creates more problems than it solves and doesn't give you enough data to really figure out what is working. Another thing might be to just try to keep everything in balance. Too much fruit at once can even cause the trots in many adults, so don't let him tank up all at once. Instead, a bit of sweat potato would be easy on the stomach. Also consider feeding more bland easy to digest food like banana and applesauce as the fruits. And the sweet potato is also easy to digest and easy on the stomach. If that doesn't work, then you will have to try eliminating more things. But I'd say just give it a bit of time and also, might want to make changes gradually for him so as not to shock his system too much. LIke if you decide to cut down fruit intake, might not want to do it suddenly but slowly instead. If you are just eliminating one food, it's not so hard, bu tif you are eliminating a whole food GROUP, it could be much harder for him to adapt quickly.

Also, another clue here that was not much talked about is you said he is a twin. Is he an identical twin? If so, interesting the other did not get this same prob. It would point to it not being entirely genetic but also very environmental. I keep thinking about how your doc said that you HAD to give a diary fortifier and then later he tested as allergic to diary. Good way to really mess up the gut flora and intestines of the poor kid. Makes me really wonder what was in that fortifier. Other supposedly 'nutritious' supplements I have seen seem to consist mostly of corn oil. Ick.

Poor little guy! I hope he feels better soon; he is lucky to have a paleo-mom! I have heard that eating fruit on top of other foods can cause bloating; food timing and combining might be something to play around with- maybe just let him have fruit in the morning?

He sounds like me, poor baby. It's very probable I have fructose malabsorption, I am also highly sensitive to gluten and most grains. You've gotten excellent advice already. I'll just echo to ADD LOTS OF CLEAN STARCHES (potatoes, sweet potatoes, squash, roots, white rice). High calorie, high fat, plenty of starch, lots of seafood/meat/eggs, low toxins.

You are an awesome mom! Coconut can sometimes be a tree nut allergy, due to it being a tree nut. It was recently classified as a tree nut. My daughter has a tree nut allergy, but isn't alleric to coconut, but HATES it. I agree with the fructose issue, maybe some lower sugar fruits just to let him have some (berries). Your son is very lucky to have you!

pecanbread.com is a helpful site for families with kids who have gut issues; the nutritional approach is the specific carbohydrate diet, with a special focus on special kids. Perhaps this, along with all the wonderful work you are doing, will be what works. Elaine Gottshcall's book, Breaking the Vicious Cycle, explains her specific carbohydrate approach. There are certain carbohydrates that cause problems; very compatible it seems to me with a paleo approach.

Cooking with lots of Coconut Oil will help add fat to the diet (assuming you keep the coconut for a while). We have a scrawny 5 year old (also premature at birth, w' gluten & dairy issues), while her height is above average she is a complete stringbean... lol We are trying this ourselves... Good Luck!!

A good friend of mine had a kid with serious digestive issues -- bloating, diarrhea, nausea, etc. They went down the "elimination diet" and "leaky gut" roads on and off for years, with some success, but did not get to the bottom of it.

What finally fixed it for them was discovering the kid had fungal overgrowth in his gut, though it is possible that he actually had several issues and they solved the others and the fungal isssue was the last one. The solution for this was, of all things, to eat lots of garlic. The kid was around 4 at this time and they just packed garlic into everything -- roasted, with potatoes, pureed with vegetables, etc. This treatment was recommended by a naturapath, and there are other options too, but I thought this was a particularly fun and natural solution.

Not suggesting that this exactly or the only thing your kid has, but I would include it in the list of possibilities. Good luck.

http://www.drlwilson.com/articles/HEALING%20LIFESTYLE.htm

super basic and ubiquidous

My boyfriend had an awful time as a kid- he is the main reason I got into this diet, trying to find a solution for him! First, has he been tested for allergies yet? Testing for allergens with an allergist could show definitively what to avoid like the plague in your diet (and eradicate from your household environment entirely) and any things in the environment that might not be helping his immune system. The period of time my boyfriend was in the best health as a kid was when he was eating lots of lamb, veal, beef, and some vegetables. Fruits gave him eczema and rashes, so he never had any fruit in his diet. If calories are a problem, getting him to drink beef broth, covering veg in coconut oil, olive oil, and ghee would be helpful.

Another thing- if it gets bad and he isn't gaining weight, it probably is obvious, but don't mess around trying all the alternatives. If he has a parasite or a bacterial infection, it can do much less damage in the long run to have a short course of antibiotics, then be able to start from scratch with a healthy, bacteria and parasite free system. It would be worth it if things don't improve in a reasonable time period to get an analysis for parasites or infection. Our current doctor figures my boyfriend had a parasite for some time during childhood, and because it was never treated my boyfriends height was significantly stunted due to such a low weight. Try to get all those calories in there with as much good food as possible, but don't be afraid to treat a parasite or bacterial infection properly, then move on.

Another thing- if your son has a hard time eating things when he has a stomach ache, one of the easiest things I find to eat when I have a stomach ache is white rice cooked in bone broth. Great, bland way to get a little energy and nutrients in the body when it doesn't feel like eating, might work for him too!